Dispute Specialist

WelbeHealth, LLC.; United States; Remote; USD 70,000 - 81,000; Full time

Benefits offered by this job

Medical insurance

PTO and holidays

401K savings + match

Advancement opportunities

Additional benefits

Job summary

WelbeHealth, LLC. seeks a Dispute Specialist to oversee and resolve first-level disputes with providers on claim payments and denials. You will work with teams to identify trends, educate providers, and ensure compliant processing.

The role requires strong claims processing background, familiarity with MS Office tools, and excellent communication skills to support provider satisfaction and policy adherence.

Qualifications

• High school diploma or equivalent; professional experience may be substituted.
• 3+ years health plan claims processing experience; 2+ years disputes experience.
• Strong computer skills; familiarity with Excel, Outlook, PowerPoint, Word, Teams.
• Ability to navigate state/federal websites and medical billing guidelines.

Responsibilities

• Examine claim records to investigate and resolve first-level disputes.
• Process acknowledgment and determination letters with notes on actions taken.
• Create correspondence for the Senior Examiner and identify processing trends.
• Maintain working relationships with team members and leadership.
• Maintain knowledge of claim processing guidelines and compliance requirements.
• Assist with data entry of incoming clean claims when needed.

Skills

Claims processing

Dispute resolution

Communication

Education

High school diploma or equivalent

Tools

Excel

Outlook

PowerPoint

Word

Teams

Job description

At WelbeHealth, we serve our communities’ most vulnerable seniors through shared intention, pioneering spirit, and the courage to love. These core values and our participant-focus lead the way no matter what.

The Dispute Specialist plays a crucial role in overseeing and resolving first-level disputes between WelbeHealth and its contracted and non-contracted providers regarding claim payments, claim denials, and contractual agreements. This role works closely with departmental team members and internal partners to identify trends and educate providers on proper processing, to ensure we are compliant in all claims related processes and to promote provider satisfaction.

• Examine claim records and forms to investigate and resolve first level disputes, meeting and maintaining established quality and production standards
• Process the completion of acknowledgment and determination letters, as well as provide detailed notes on actions taken, such as dispute decision and reasoning
• Create correspondence for the Senor Examiner and work closely with leadership on improper processing trends and claim related concerns resulting in disputes
• Establish and maintain effective working relationships with team members and interdepartmental staff and leadership
• Maintain comprehensive knowledge of claim processing guidelines, procedures, governing regulations, and compliance requirements
• Assist with the data entry of incoming clean claims in times of need

Qualifications and Requirements:

• High school diploma or equivalency, professional experience may be substituted
• Experience in a Managed Care Plan (MCP) or PACE organization (PO) claims processing environment
• Minimum of three (3) years of health plan claims processing experience, and two (2) years of health plan claims dispute experience analyzing and resolving provider claims
• Strong computer and software knowledge (e.g., Excel, Outlook, PowerPoint, Word, Teams), as well as job-specific applications/systems to produce correspondence, charts, spreadsheets, and other relevant information
• Ability to navigate the complexities of state/federal websites and medical billing guidelines, using online resources to resolve outstanding claims and disputes
• Excellent verbal and written communication skills, organizational and time management skills, and problem solving and decision-making skills

Benefits of Working at WelbeHealth: Apply your expertise in new ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for.

• Medical insurance coverage (Medical, Dental, Vision)
• Work/life balance - we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and sick time
• 401K savings + match
• Advancement opportunities - we’ve got a track record of hiring and promoting from within, meaning you can create your own path!
• And additional benefits

Compensation consists of base salary plus bonus. WelbeHealth offers a competitive total rewards package that includes a 401(k) match, comprehensive healthcare coverage, and a broad range of additional benefits. Actual compensation will be determined based on experience and relevant qualifications.

$33.80 - $39.14 USD

At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.

Our Commitment to Diversity, Equity and Inclusion

At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), pregnancy or other status protected by applicable law.

Voluntary Self-Identification

For government reporting purposes, we ask candidates to respond to the below self-identification survey.Completion of the form is entirely voluntary. Whatever your decision, it will not be considered in the hiringprocess or thereafter. Any information that you do provide will be recorded and maintained in aconfidential file.

As set forth in WelbeHealth’s Equal Employment Opportunity policy,we do not discriminate on the basis of any protected group status under any applicable law.

If you believe you belong to any of the categories of protected veterans listed below, please indicate by making the appropriate selection.As a government contractor subject to the Vietnam Era Veterans Readjustment Assistance Act (VEVRAA), we request this information in order to measurethe effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Classification of protected categoriesis as follows:

A "disabled veteran" is one of the following: a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.

A "recently separated veteran" means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An "active duty wartime or campaign badge veteran" means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An "Armed forces service medal veteran" means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.